Oral Health

1. BLEEDING

Telangiectases can easily rupture, especially in the oral mucosa, causing haemorrhages which are sometimes difficult for the patient to control. We should bear in mind that the oral mucosa is very thin compared to the skin, and therefore oral vascular malformations have very little protection – making them more prone to bleeding.

How to avoid bleeding of oral telangiectases

• Use a soft-bristled toothbrush
• Floss only in areas free of telangiectases
• Avoid hard, hot and irritating foods
• Use lip sunscreen in the event of sun exposure
• Keep your dental prosthesis (if you use one) in good condition, making sure
  that it fits properly and does not damage the gums or irritate telangiectases.

What to do in case of bleeding of oral telangiectases

• Wash hands thoroughly
• Locate the source of bleeding
• Use finger pressure (on gauze) on the bleeding point for 15 minutes to stop bleeding. The gauze can be soaked in tranexamic acid. Repeat until bleeding stops.
• If you are unable to control the bleeding go to your nearest hospital Emergency
  dept.

2. BRAIN ABSCESS

HHT patients with lung AVMs (arteriovenous malformations) are at increased risk of suffering brain abscesses following dental procedures. Bacteria resident within the mouth can migrate into the bloodstream and pass through lung AVMs towards the
brain.

How to prevent brain abscess from oral bacteria

Personal Oral Health Care

• Brush your teeth thoroughly after every meal
• Drink plenty of water to prevent dehydration and plaque build-up
• Avoid smoking
• Keep your dental prosthesis (if you use one) clean and properly disinfect your
  mouth by using an oral antiseptic mouthwash

• Inform your dentist that you have HHT or that you may suffer from it due to family history. If the dentist is not familiar with the disease, inform him/her appropriately. You can also suggest that he/she contacts your referring HHT doctor.
• Have regular check-ups. Gum problems (gingivitis, periodontal disease), cavities, or any other oral conditions you may have should be treated as soon as possible.
• Antibiotic Prophylaxis. These should be used during any invasive dental procedure where lung AVMs have not been treated or where screening of the lungs has not yet been performed. Suggested dosage: Amoxicillin by mouth – Adults: 2gr. Children: 50mg/kg body weight. Single dose 60 minutes before procedure. In case of penicillin allergy: Clindamycin oral: Adults: 600mg. Children: 20mg/kg.

In particular if you or any family members have been screened for AVMs in the lungs it is imperative that you inform your dentist about HHT. Early diagnosis could be made during a simple visit to your Dentist. Where screening of the lungs has not yet ruled in or ruled out any AVMs – caution should still be taken.

“The role of dental professionals in early HHT diagnosis is crucial. By paying attention to specific symptoms and signs, they can help identify the disease at an early stage. An early diagnosis can help patients avoid serious complications and improve their quality of life.” – HHT Sverige

Oral manifestations and dental considerations in patients with hereditary hemorrhagic telangiectasia – a summary review. 

In August 2023, Julia Niklasson, Adnan Lidian, Anders Rönnblom and Andreas Thor, at Uppsala University, published an in-depth article about  the mouth and HHT. 

The study aims to review previous research on the oral and dental consequences of hereditary hemorrhagic telangiectasia (HHT) to determine the scope, type and area of ​​this research and to identify any knowledge gaps in the field.

Read the original article here: HERE